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Fasciotomy increases risk of infection, nonunions in patients with tibia fractures
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SAN ANTONIO — Fasciotomy for acute compartment syndrome increases the risk of deep infection, delayed union and nonunion in patients following surgery for tibia fractures, according to a recent presentation.
For their study, study investigator Dan Kemper, MD and colleagues sought to compare the complications and time to union in patients who had operatively managed tibial fractures and treated with or without fasciotomy for acute compartment syndrome.
“Our hypothesis was that time to union is unaffected by the presence of fasciotomies, delayed union is no more prevalent for compartment syndrome vs. controls and deep infection rates are unaffected by presence or absence of compartment syndrome in operative tibia fractures,” Kemper said.
The team retrospectively reviewed data gathered between January 2000 and August 2010 on 149 patients with acute compartment syndrome related to fasciotomy. The study included skeletally mature patients with tibia plateau or shaft fractures up to a Gustilo-Anderson grade of 3B that required internal fixation and concomitant compartment syndrome treated with 4-compartment, 2-incision fasciotomies. All of the patients had complete follow-up with clinical/serial radiographic examinations at 2 weeks, 6 weeks, 12 weeks or longer.
The researchers compared patients with compartment syndrome treated with fasciotomy to a control group of patients without acute compartment syndrome or fasciotomy.
In patients with tibial plateau fractures, the investigators found an average time to union of 28 weeks in the fasciotomy group vs. 15 weeks in the nonfasciotomy group. Delayed union was found in 48% of patients in the fasciotomy group vs. 12% in the nonfasciotomy group. The investigators discovered higher nonunion (11% vs. 6%) and deep infection rates (10% vs. 5%) in the fasciotomy group compared to those who did not undergo the procedure.
In patients with tibial shaft fractures, union was achieved at 30 weeks in the fasciotomy group compared to 19 weeks for the nonfasciotomy group. The investigators found delayed union in 67% of the fasciotomy group vs. 28% of the nonfasciotomy cohort. Nonunion (22% vs. 1%) and deep infection rates (17% vs. 2%) were also higher in the fasciotomy group. – by Renee Blisard Buddle
References:
Kemper D, Castellvi A, Erdogan M, Sagi HC. Fasciotomy for acute compartmental syndrome increases the incidence of infection, nonunion and delayed union of operatively treated tibial fractures. Paper #50. Presented at the Annual Meeting of the Orthopaedic Trauma Association. Oct. 12-15, 2011. San Antonio.
Disclosure: Kemper has no relevant financial disclosures.
